Provider Demographics
NPI:1114068293
Name:NORTHSHORE HEALTH PARTNERS LTD
Entity Type:Organization
Organization Name:NORTHSHORE HEALTH PARTNERS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARMINIO
Authorized Official - Middle Name:
Authorized Official - Last Name:SURUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-878-3326
Mailing Address - Street 1:5140 N CALIFORNIA AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3645
Mailing Address - Country:US
Mailing Address - Phone:773-878-3326
Mailing Address - Fax:773-878-3614
Practice Address - Street 1:5140 N CALIFORNIA AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3645
Practice Address - Country:US
Practice Address - Phone:773-878-3326
Practice Address - Fax:773-878-3614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL110208482OtherRR MEDICARE
524650Medicare Oscar/Certification